The New England journal of medicine
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Letter Case Reports
Coronary arterial laceration after blunt chest trauma.
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Randomized Controlled Trial Clinical Trial
Intrathecal baclofen for the treatment of dystonia in patients with reflex sympathetic dystrophy.
Patients with reflex sympathetic dystrophy (also known as the complex regional pain syndrome) may have dystonia, which is often unresponsive to treatment. Some forms of dystonia respond to the intrathecal administration of baclofen, a specific gamma-aminobutyric acid-receptor (type B) agonist that inhibits sensory input to the neurons of the spinal cord. We evaluated this treatment in seven women who had reflex sympathetic dystrophy with multifocal or generalized tonic dystonia. First, we performed a double-blind, randomized, controlled crossover trial of bolus intrathecal injections of 25, 50, and 75 microg of baclofen and placebo. Changes in the severity of dystonia were assessed by the woman and by an investigator after each injection. In the second phase of the study, six of the women received a subcutaneous pump for continuous intrathecal administration of baclofen and were followed for 0.5 to 3 years. ⋯ In some patients, the dystonia associated with reflex sympathetic dystrophy responds markedly to intrathecal baclofen.
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Randomized Controlled Trial Clinical Trial
Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy.
Chronic reflex sympathetic dystrophy (also called the complex regional pain syndrome) is a painful, disabling disorder for which there is no proven treatment. In observational studies, spinal cord stimulation has reduced the pain associated with the disorder. ⋯ In carefully selected patients with chronic reflex sympathetic dystrophy, electrical stimulation of the spinal cord can reduce pain and improve the health-related quality of life.